The America’s Health Insurance Plans (AHIP) news wire announced today that the Obama administration will be launching a 3-year medical home program that may be available for qualifying Medicare beneficiaries in participating states. Under the new program, qualifying Medicare beneficiaries will live in a Medicare-sponsored housing facility, where they can regularly be seen by primary care physicians and skilled healthcare providers, such as nutritionists, nurse practitioners, physical therapists, and social workers.
The pilot program is design to ensure that participating Medicare beneficiaries receive a high level of care, but the program is also expected to reduce costs.
Health and Human Services Secretary Kathleen Sebelius said the new program is “better for doctors, better for patients, and better for our national balance sheet, which is why this program has such widespread endorsement.” In order to improve patient care, patients will have access to skilled healthcare providers, such as dietitians and physical therapists, which may not be covered by Original Medicare plans.
Currently, if a Medicare beneficiary requires a healthcare service that is not covered by his or her Medicare plan, the individual needs to either pay out of pocket or purchase Medicare Supplemental insurance to cover the cost of expensive healthcare services. (It is recommended for many Medicare beneficiaries that they purchase Medicare Supplemental insurance so that they can be financially covered for many healthcare services they may require that are not covered by their Original Medicare plans.)
In order for the program to work, Medicare will join forces with Medicaid, private insurers, and state-federal healthcare programs in states where the program will be provided.
Existing precedents in Vermont, Maine, Massachusetts, and Colorado
Already, the state of Vermont has established a medical home model that is proving to be effective, efficient, and affordable. In the Vermont example, private insurers work hand-in-hand with Medicaid to establish “uniform standards for ‘Advanced Primary Care (APC) models,’” which is the Vermont name for the medical homes.
Sebelius looks to the Vermont model as a successful precedent for medical home pilots and referred to them often during today’s announcement of the new Medicare option; “When Medicare, Medicaid and private insurance companies coordinate their efforts, we can improve the quality of care for Medicare beneficiaries,” she said. “As we have seen in Vermont, improved efficiencies in the system mean doctors can spend more time with their patients, provide high quality care and better coordinate that care with other medical professionals.”
The new model represents the first time Medicare participated fully in such an experiment. The new option also marks the first time compensation for all primary care physicians by private insurers will be aligned. In Vermont, 3 major insurers work along with Medicaid and the state-federal healthcare program designed for the poor to pay for the salaries of skilled healthcare providers within the facilities.
Additionally, physicians working in the program in Vermont get paid an extra $1.20 to $2.39 per patient, per month, to coordinate care and receive bonuses for their practices if a patient has improved health based on certain criteria.
Now is the time for many Medicare beneficiaries and their families to start planning for participation in the new medical homes, if they become available in their states. Moreover, Medicare participants should take time to evaluate their current medical needs and Medicare options now to ensure that they are covered for the healthcare services that they anticipate needing for the coming year. If they wish to make any changes to their Medigap plans or improve their Medicare coverage, they need to make these changes during the upcoming Open Enrollment period, which lasts from November 15 to December 31 of each year.
Are you looking for information about Medicare Supplement programs that may help you pay for your healthcare more easily? For help finding the best Medigap plans, contact Medigap Advisors at 866-323-1441.
Wiley Long is founder and president of Medigap Advisors, and is passionate about helping people navigate the confusing waters of Medicare. He is the author of The Medicare Playbook: Designing Your Successful Health Coverage Strategy, a clear and simple explanation so you can make the most of your Medicare coverage. For more information visit www.MediGapAdvisors.com.